The failure of a Dallas hospital's electronic medical record system to flag a man who turned out to be infected with the Ebola virus underscores how clunky, outdated and inefficient health information systems typically are in the U.S., a medical IT CEO charged Friday.
"The worst supply chain in our society is the health information supply chain," said Bush. . . "It's just a wonderfully poignant example, reminder of how disconnected our health-care system is."
"It's just a very Stone-Age sector, because it's very conservative," Bush said. "Hospital health care is still in the era of pre-Internet software."
"The hyperbole should not be directed at Epic or those guys at Health Texas," Bush said. "The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network . . . People trying to recreate their own micro-Internet inside their own little biosphere . . . that'll never, never, never be excellent," Bush said. "There's no 'network effect' in health care today."
The hospital Thursday night said when Duncan was first examined Sept. 25 by a nurse, he was asked a series of questions, including whether he had traveled outside of the U.S. in the prior month.Of course, that particular problem at that particular hospital is now fixed. But . . .
"He said that he had been in Africa," the hospital said in a statement. "The nurse entered that information in the nursing portion of the electronic medical record."
But it turns out that answer—which could have alerted doctors of the possibility Duncan had Ebola—was not relayed electronically to them because of "a flaw" in the way doctors' workflow portions of the electronic health records interacts with the nursing portions of the EHR.
"In our electronic health records, there are separate physician and nursing workflows," the hospital said. "The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician's standard workflow."
"We have made this change to increase the visibility and documentation of the travel question in order to alert all providers," Texas Health said. " We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola."Mr. Bush was quite tactful, but the implication of his statement is truly astounding. He is saying, perhaps not quite in so many words, that the IT department of the Texas Health hospital in Dallas, by poorly implementing (my opinion, not necessarily his) poorly designed (again, my opinion, not necessarily his) software, could be responsible for a disaster. This glitch has potentially allowed Ebola to spread further than it would have had Mr. Duncan been put immediately into confinement upon his first presentation. To be fair, the patient had been in contact with others before his first ER trip; still, we can assume he had more interaction with more people than he might have otherwise. We can only wait and see how many of his family members and acquaintences come down with the often-fatal disease. I should also mention that the ER physician should probably have thought to ask about foreign travel when presented with a feverish African national presumably speaking with an accent.
Bush noted that typically when problems like the flaw in Texas Health's EHR system are fixed, "they're fixed only at the place where they appeared."
"Those mistakes are happening constantly," Bush said.
But, "philosophically I think hospitals should get out of the business of trying to program computer systems, and expand in the business of treating patients. But that's a standard thing that goes wrong with millions of configurations" of EHRs, he said.
Faulkner, an influential Obama campaign finance bundler, served as an adviser to David Blumenthal. He’s the White House health information technology guru in charge of dispensing the federal electronic medical records subsidies that Faulkner pushed President Obama to adopt. Faulkner also served on the same committee Blumenthal chaired.I'm straying a little off-topic here, but I think it is unlikely in the extreme that Epic will shoulder even the slightest blame for Mr. Duncan's Dallas destruction. After all, as we say in the trade, PBKAC, Problem (was) Between Keyboard and Chair. In other words, it wasn't Epic's fault that whatever IT employee or committee failed to connect the dots and the map the critical foreign travel field from the nurses' intake screen to the doctors' review screen. Oops. So sorry.
Cozy arrangement, that.
Lawyers for the nation’s largest flight-attendant union argued in federal court Friday to effectively reinstate a government ban on the use of electronic devices during takeoffs and landings.ONE tablet flew, and we have to take everyone's away. How do we know it wasn't thrown?
The Association of Flight Attendants-CWA is suing the Federal Aviation Administration, saying the agency notice last year that paved the way for fliers to use their devices throughout flights violated federal regulations that require passengers to stow all items during takeoffs and landings.
Justice Department lawyers representing the FAA say the agency’s guidance, which permitted fliers to keep smaller devices in their hands during all phases of flight, doesn’t violate the stowage rule because small devices aren’t governed by it. The two sides argued the case Friday to a three-judge panel with the U.S. Court of Appeals for the D.C. Circuit. . .
Attorney Amanda Duré, who is representing the attendants union, said that since the policy change, many fliers have stopped listening to attendants’ emergency announcements and, in at least one incident, a tablet became a projectile during turbulence. The union also is concerned the devices could impede passengers’ exit from an aircraft during an emergency.
1. Coded hand gesturesCoffee, Tea, or Dalai?
Flight attendants "employ all sorts of unofficial methods and codes" to deal with difficult fliers, reports Emma Messenger at the Daily Mail. A "subtle wag of a finger" behind someone's head means that he's lecherous and may get handsy (or worse) with the staff. To alert colleagues that a passenger is drunk, attendants cross their fingers over the hospitality cart.
2. High winds
At the end of a demanding flight, writes David Sedaris in The New Yorker, some attendants indulge in the peevish practice of "cropdusting" — silently passing wind as they walk down the aisle making their final checks. "Reclined in their seats, heads lolling to the side ... airplane passengers are prime fart targets," comments Maureen O'Connor at Gawker.
3. Dirty drinks
Ellen Simonette — author of Diary of a Dysfunctional Flight Attendant: The Queen of Sky Blog — reminisces in The New York Times about the time a colleague took revenge on a loudmouthed passenger by making him "a very special drink" in the privacy of the galley, rubbing the rim of his glass on the plane's "filthy floor" before serving it up with a "devious smile."
4. Abusing their powers
We've all seen the seat-belt sign light up in midflight, though there isn't a hint of turbulence. Blame your attendants, says the Daily Mail's Messenger, who often switch it on so they can "have a nice cup of tea and gossip in peace."
5. Starting a blog
Countless flight attendants vent about passengers by blogging anonymously. Dubai-based blogger Tampax Towers recently railed against fliers who hold up security lines by wearing metal-studded jeans, while, over at These Wings Talk, a catty account of an experience with a "One-Eyed Cyclops Passenger" makes for surprising reading.
Dalai's note: A piece by Dr. Richard Gunderman posted on TheHealthcareBlog.com. It is unclear whether or not Dr. Gunderman's "discovery" is a real document or not. Still, it would seem to explain a lot of what we are seeing in healthcare today...
In moving from healthcare to health, consumers and patients must be enabled to make healthier, more cost-effective choices.
A large part of success may be determined by how we develop incentives to bring attention and pull to those choices. One of the leaders in this area, who’s been driving successful consumer engagement through incentives for over a decade, is Michael Dermer, Chief Innovation Officer at Welltok. I had the pleasure of sitting down with Michael a few weeks ago to talk about what we can do to help people make the right choices for health.
Here is part one of my Interview with Michael Dermer, the Chief Incentive Officer at Welltok, developer of CafeWell, a leading health optimization platform, that rewards participants for leading healthier lives.. In Part II will discuss a bit more about Apple and how to get different populations engaged.
LK: As we move from health care to health (projections are that half of payments will be value-based by 2022, according to Leavitt Partners), tell us how you got into the health incentive business, a little of the IncentOne story (Michael Dermer’s previous company that was acquired by Welltok just over a year ago), and why it’s so important to this Copernican moment, where patients move to the center of the universe of health care.
MD: If you go back 10 or 15 years ago, I was a corporate lawyer in New York and just randomly stumbled upon the incentive business and ultimately the health care business. I had seen statistics that said for women who follow their prenatal care, their costs are (generally) the costs of the tests and the delivery claims. But for those who don’t follow their prenatal care, the risk to themselves and the increased risk to infants can cost the healthcare system literally millions of dollars.
That just really struck me that the medical profession knew what behaviors they wanted consumers/patients and even providers to take, but weren’t very good at getting people to do what are often simple, proven things (to reduce health risks) even in situations where the intrinsic motivations are seemingly very high.
In every other industry other than healthcare, incentives and rewards were and are a foundational way to accomplish that. So, in the mid 2000’s with IncentOne, we said, if it all comes down to consumer and provider behavior, then incentives aren’t just a one-off, $25 reward for a health risk assessment, for example, they’re a foundational asset that should be a cornerstone to your consumer and provider engagement strategy.
Back then incentives were kind of like witchcraft and people would say we’re never going to pay people to do things they should be doing already. So it’s been a really interesting ride to see how things have evolved to where incentives have become a cornerstone tool (to health) and the success we’ve achieved with IncentOne and now with Welltok.
LK: So tell us about some of the incentives you’ve used, how things have changed in the incentive business, and what’s coming in the near future.
MD: If you go back, consumer-based incentives, delivered via self-insured employers and some health plans, were really basic: complete a health risk assessment, sign on to a portal, maybe go see your PCP, biometric screening, etc. As more and more wellness programs became prevalent in both employer and health plan communities, they started to do more around smoking cessation and online coaching. So if you look at it holistically, as the different health assets were being deployed by anyone who bore the risk, more and more of those behaviors started to be rewarded.
Fast forward today, think of telemedicine to transparency tools, to wrapping them around digital devices and apps in addition to all the traditional things around biometrics and outcomes. We have a real extension to providers with things like e-prescribing and the ACO infrastructure. What do we get from changing the behavior of providers?
So it’s been a constant evolution. Once people say “we know what the behaviors are, we know what impacts the system” then it becomes an evolution from the basic things like screenings and primary care to how to redirect people from the ER if they have the sniffles to a more appropriate care center (and much more specific decisions points). I think we now have over 6,000 behaviors we’ve rewarded over the years.
LK: So with things like telemedicine, you’re saying, “Hey, call in instead of going to the clinic and we’ll reward you for that?”
LK: What kinds of rewards do you offer for those kinds of things?
MD: Our view of the world is that different players in the healthcare continuum would want to use different dollar values and offer different types of rewards. So we always look at those two things differently.
Our first part is, how much do you actually give someone? If you give someone $50 to do a screening, you’ll get a lot more participation than if you offer $50 to run a marathon. So our first part, was what’s the dollar value? And the second part, what are all the different rewards? So from an administration perspective, that means everything from cash to HSA and HRA contributions, premium credits, gift cards, debit cards, that whole continuum of rewards that’s used in the most prevalent way. In our view of the world, the rewards that approach cash have the best results, and it’s the amount that you’re giving someone relative to the value of the behavior that is the true art and science behind all of this.
LK: Do we always get those lines to cross, between the behavior and the reward? Does it always make sense?
MD: That’s really the rub at the end of the day. So if you take things, a simple example, like you sprain your ankle and you need an MRI, and you need to decide where to have it done. At one place it’s $600 and one is $1,800, that’s simple and it’s easy to create appropriate incentives to steer people to a different service center in that instance. When you get a little deeper into long-term behavior change, that’s more complicated.
You know stopping smoking and managing nutrition and weight have longer-term benefits, but are harder [to change]. So it’s a matter of managing the benefit and the value of the behavior. It’s hard to get someone in Medicaid to stop smoking, but it’s not so hard to get them to go to a primary care doc for $50.
So, one part is how much you give them and the second part is how much it’s worth. There are lots of behaviors that have near-term benefit, the hope is that then leads to some intrinsic motivations and longer-term behavior change, but it ultimately comes down to how much you’re saving.
LK: Is the goal that these extrinsic rewards eventually become intrinsic rewards?
MD: They work hand in hand, neither will get the job done by themselves. I don’t think we’ll ever see a day where we don’t need extrinsic rewards. With all the changes in health care, you see them everywhere. If you work for a large, self-insured employer, they’re becoming commonplace. But extrinsic rewards don’t work on their own either, so what you want to do is use extrinsic for one-and-done kinds of activities, like choosing a place to have an MRI done, and then unlock more intrinsic motivations.
You’ll hear lot of stories like someone says, “Yeah, I never really exercised and never really thought about it, but I did a 10,000 step program, in response to an incentive, and something clicked.” Or a family member got them to join a competition and something clicked because they were part of a competition together. All of these things become arrows in your incentive quiver.
I’ll also say, when you look at the numbers, there’s no starker example than prenatal care. The idea of not following prenatal care may seem pretty foreign, but it’s commonplace even with so much intrinsic motivation, so we need to deploy extrinsic with intrinsic to optimize where you end up.
LK: So, let’s look at how much it takes to drive these incentives. You’ve collected a lot of data for more than a decade. Do have a good idea where to start? If you look at, say, airline miles, they’re worth maybe somewhere between a penny or a nickel. How do you know what it will take to drive a specific behavior?
MD: The reason I mentioned before that things need to be closer to cash is that you don’t want people to have to do those kinds of conversions. It’s just dollars. You’re getting real dollars. What we can do now that we have been doing this for over a decade, is we know what dollar value it takes to motivate around a certain behavior.
Our methodology is, we look at behavior in five different categories from simple things, like doing a health risk assessment, all the way up to changing lifestyle on the other end of the spectrum. And with all our data, we know how much reward will get you how much behavior change.
LK: How do you get people started on these programs? How do you get them in front of those that need to hear about them?
MD: If you think about the major sponsors, health plans, employers, now even more government agencies, reward and incentive messages are integrated into those offerings. So, if an employer is going to spend $1,000 on rewards, it becomes part of their health and wellness brand and communications, and the same goes for health plans. While health plans have been a little more tactical up until now, we’re not too far away from every health plan having a reward program just like credit cards, airlines and hotels. In the near future, we’ll see reward programs become a pretty core part of why consumers engage (with health plans), and it’s already becoming a core part of the communications strategy.
LK: In this new model that we’re heading toward, moving from healthcare to health, it seems like the core pieces are in three buckets: 1) there’s big data and analytics; 2) there’s measurement, health, sensors and home monitoring; and 3) then there’s incentives. It really seems like what Welltok and you are doing is really pulling all these components together on a common technology platform. How do all these pieces fit together, are we headed toward a behavioral health currency of some sort?
MD: It’s really interesting the way you describe it, because people used to say it’s preventative, or now it’s transparency, but we look at as all of the above. We say it’s a universe of behaviors, and they each might have immediate, intermediate, or long-term incentive applications.
One of the analogies from outside health care is Citibank. Citibank for years, like many large financial institutions, used to have these disjointed incentive programs. You’d get, say, a $200 television for opening an account, $50 for sitting down with a small business manager, and 1% back for using your credit card. Now that’s all rolled into a program called Citi ThankYou Rewards where everything you do with Citibank is rolled into one rewards program.
Another example is children with asthma. Parents might take their kids to the ER four times a year, but if they just had a fast-acting inhaler prescribed, they’d be safer and better off and it would save the system thousands and thousands of dollars.
So, with the list of different examples and risk factors, different associated behaviors, and all the assets that the health plan and employers are delivering is endless. So, I think we’ll soon see a continuum where it all comes together and starts to look a lot like ThankYou rewards, but for healthcare.
Thanks to Michael Dermer! Stay tuned for Part II on how to approach different patient populations and what the Apple Watch may mean for health care incentives and payments.
During this tech boom, is it a coincidence that the tech savvy San Francisco Giants are in the World Series for the third time since 2010? In this post, we take a look at the relationship of technology, leadership, big data analytics, and baseball. In particular, we explore how Major League Baseball manages its player/patient population, and the trends they are following since converting players from paper medical records to EHR.
Baseball teams are very secretive about how they use their data. Teams, like the San Francisco Giants, employ a slew of data analysts and data tools, but every team is reluctant to share how data is used, and where they derive insights. According to the 2014 SABR Analytics Conference, the new frontier of baseball data is not just about scouting players, but keeping players healthy and injury-free. The new area of research, just in in its infancy, is marrying baseball statistics with medical injury research.
Medical analysts are the new data darlings of baseball operations.
Chris Marinak, Sr. Vice President of Major League Baseball, implemented MLB’s switch to electronic medical records, and believes medical injury research will provide new insights over the next five or ten years,
I actually joined MLB in 2008, and I was shocked to see that we didn’t have a system for tracking injuries or medical information at a de-identified level. We were literally keeping a lot of paper documents and putting them into a filing cabinet. It was time for us to get into the 21st century.
So starting in the 2010 season, we rolled out an electronic medical records system working with the players’ association that allows our medical staff to enter in medical information on every single player injury and the treatments that those players get. And then that information is all stored in one place, so that when you go from one team to the next, it flows along with you.
Marinak says the ancillary benefit is that MLB now has an injury tracking system where they can track trends in the industry.
This data is analyzed at a de-identified level to find the drivers of lost time, and the injuries keeping players off the field. “So we can hopefully keep them healthier,” according to Marinak.
Baseball is a sport that has always been hungry for statistics. Sabermetrics, the study of baseball’s in-game play, has been around since the middle of the 20th century. But in 2002 and 2003, Sabermetrics became “Moneyball” as the Oakland As advanced to the playoffs with their analytic approach to assembling a competitive team, despite a lack of competitive dollars.
With the advent of new technologies, PITCHf/x data and Sportsvision video in 2006, the world of baseball was set to explode with big data and predictive analytics. Detailed data became accessible for every hit and pitch in a game.
Batting and pitching biomechanics also started to be video analyzed at the high school level. In 2009, my son clocked an official bat speed of 101 miles per hour, one of the fastest recorded bat speeds in the country for any amateur or professional player.
Bat speed is recorded via a static ball test, hitting off of a tee; exit speed is recorded hitting a pitched ball.
An injury sidelined his play, so he started experimenting with this new PITCHf/x data. His early web-based program would let you compare MLB pitchers and batters, and team matchups. Having baseball experience would help him provide insights for an individual player’s performance enhanced by data visualizations like heat maps.
Although PITCHf/x stated its data could not be used for commercial purposes, it didn’t take long for the financial world to play ball – Bloomburg Sports was born in 2011. The company’s latest technology (recently sold) has the capability to create every imaginable data point from video captured from play performance, whether that video is captured live or from a stream.
Do you want to know how many times a player licks his lips before fielding a ball? – Dan Cohen, Bloomberg Sports
Dr. Glenn Fleisig of the American Sports Medicine Institute says they look at what a person’s body is doing and that’s what biomechanics is, “Tracking where the ball went is all good, but we look at how did their body get there. The new thing teams are embracing is biomechanics.” More information will come from wearable tech and self-tracking technologies.
MLB is doing a lot more tracking of player movements utilizing Trackman and through studies at MIT. Marinak says having more of that information publicly available will be important to innovation, but right now it’s just too big, “A game’s worth of data in Trackman is 7 terabytes. So we’re talking about big data at a massive scale.” He cautions that how this data is treated will be different because it is medical information, and keeping a player’s medical information needs to be private.
Dr. Stan Conte (formerly with the SF Giants and now with the Los Angeles Dodgers) is a leading expert in medical injury research in baseball. He says they focus on “changes” in the data. He explains medical data is dirty data, so it is very difficult to analyze.
The data is getting better, and with more data, we’ll be able to go into areas that we hadn’t thought about before. – Dr. Stan Conte
But now that PITCHf/x also tracks every defensive play, it has been reported that the San Francisco Giants do defensive shifts better than all MLB teams. Is the team’s proximity to Silicon Valley, and its innovative CIO Bill Schlough, its World Series advantage? Or is it their overall focus on innovation?
The San Francisco Giants are dedicated to enriching our community through innovation and excellence on and off the field.
In 2004, the SF Giants were the first to offer Wi-Fi throughout their stadium. Today, approximately 35% of fans are online at games. The stadium’s “fat pipe” allows fans to easily upload content via the Giants app or social channels like Faceboook, Twitter, and Instagram.
In 2009, SF Giants CIO Bill Schlough introduced dynamic ticket pricing (DTP), allowing the price of game tickets to go up or down depending on popularity and availability. Other teams now use DTP, and the idea has spread to restaurants, movie theaters, and the performing arts.
— #OctoberTogether (@SFGiants) June 24, 2014
This year, the SF Giants opened a 4,320 sq. ft. edible garden and restaurant, affectionately called the “kale garden”, that sits overlooking center field. In addition to providing healthy fare for fans and players, the innovative garden will be used as an open-air classroom for students during the Giants’ off-season, where Bay Area youth will go to learn about sustainability, urban farming and healthy eating.
Gaining respect early as a technology leader was key for Schlough’s career, as the Giants let him run his own department with the ease and precision he wanted to do it in. It’s tremendous the impact Schlough has had on the Giants, but eventually that impact will affect the MLB as a whole. – Justin Kasser
Now, let’s play ball!
First, do no harm.
Four simple words that are synonymous with healthcare. It’s a principle that everyone in the industry – not just physicians – should adhere to.
So shame on us all for our part in allowing an EHR vendor to shut off a practice’s access to their patients’ medical records and for recklessly putting patients at risk.
Background: Full Circle Health Care in Maine purchased an EHR from HealthPort in 2010. Originally the maintenance fees were $300 a month. A few months later CompuGroup Medical purchased HealthPort and increased the maintenance fees to $2,000 a month. The practice protested the price increase and claimed CompuGroup failed to deliver hardware upgrades that had been paid for. The parties spent several months arguing and for 10 months the practice did not pay its maintenance bills. Finally in July, CompuGroup shut off the practice’s access to its medical records.
The details as to why the fees jumped so much and whether CompuGroup had the legal right to do so are a little unclear. What is clear is that multiple parties are at fault for allowing such a mess to occur.
Let’s start with the government, which created the HITECH program and promised thousands of dollars for providers willing to adopt and meaningfully use EHRs. Though the objectives were admirable, CMS failed to adequately address all the “what if” scenarios in its rush to move the program forward. The legislation and final rule provide no guidelines for protecting patient records in the event of a vendor/provider disagreement, financial hardship, or business discontinuance. Undoubtedly we’ll see plenty more disputes like this one in the coming years.
The practice also gets a share of the blame. The owner should have invested in legal advice before signing a $72,000 contract for something as critical as an EHR system. Did she skip this step in her haste to achieve Meaningful Use and earn incentive payments? Furthermore, even if she disputed the increase in maintenance pricing, shouldn’t she, at a minimum, have continued paying the $400 a month fee she believed was the correct amount? Perhaps the vendor would have been more willing to come to an acceptable agreement if she hadn’t stopped paying altogether.
CompuGroup, of course, looks like the really bad guy here. The multi-national company has annual revenues of about $600 million. Did they really need to pull the plug on this practice over a piddling $40,000? The company’s general counsel says the situation is similar to an electric company shutting off power when a customer fails to pay. Perhaps, but many municipalities and some states have laws that prohibit the discontinuance of services under certain conditions, such as in extreme cold weather or when a child or sick person is in residence. In other words, there are laws to protect consumers against potentially harmful actions. (See: EHRs And The Law: When Interoperability Isn’t a Choice)
Which brings us to the seemingly forgotten patient, who arguably is – or should be – the owner of his or her own record. We do have federal and state laws that give patients the right to access and inspect their medical records. Perhaps the practice’s 4,000 patients should all send CompuGroup a written request for a copy of their records. Maybe an attorney who is smarter than me should look into that.
Until the mess is settled, we have a practice seeing patients without the benefit of medication and allergy lists, details on previous treatments, or lab and test results. And everyone involved is hoping that no patients are harmed.
Whether our role in healthcare is policy maker, technology developer, provider, or HIT geek, we really need to do better.
Healthcare executives are continuously evaluating the subject of RFID and RTLS in general. Whether it is to maintain the hospitals competitive advantage, accomplish a differentiation in the market, improve compliance with requirements of (AORN, JCAHO, CDC) or improve asset utilization and operating efficiency. As part of the evaluations there is that constant concern around a tangible and measurable ROI for these solutions that can come at a significant price.
When considering the areas that RTLS can affect within the hospital facilities as well as other patient care units, there are at least four significant points to highlight:
Disease surveillance: With hospitals dealing with different challenges around disease management and how to handle it. RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.
Hand hygiene compliance: Many health systems are reporting hand hygiene compliance as part of safety and quality initiatives. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS hand hygiene protocol and compliance when clinical staff enter or use the dispensers can now be dynamically tracked and reported on. Currently several of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.
Locating equipment for maintenance and cleaning:
Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.
A recent case of a hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took an average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.
There are also other technologies and products which have been introduced and integrated into some of the current RTLS systems available.
There are several RTLS systems that are integrated with Bed management systems as well as EHR products that are able to deliver patient order status, alerts within the application can also be given. This has enabled nurses to take advantage of being in one screen and seeing a summary of updated patient related information.
Unified Communication systems:
Nurse calling systems have enabled nurses to communicate anywhere the device is implemented within the hospital facility, and to do so efficiently. These functionalities are starting to infiltrate the RTLS market and for some of the Unified Communication firms, it means that their structures can now provide a backbone for system integrators to simply integrate their functionality within their products.
In many of the recent implementations of RTLS products, hospital executives opted to deploy the solutions within one specific area to pilot the solutions. Many of these smaller implementations succeed and allow the decision makers to evaluate and measure the impacts these solutions can have on their environment. There are several steps that need to be taken into consideration when implementing asset tracking systems:
• Define the overall goals and driving forces behind the initiative
• Develop challenges and opportunities the RTLS solution will be able to provide
• Identify the operational area that would yield to the highest impact with RTLS
• Identify infrastructure requirements and technology of choice (WiFi based, RFID based, UC integration, interface capability requirements)
• Define overall organizational risks associated with these solutions
• Identify compliance requirements around standards of use
RFID is one facet of sensory data that is being considered by many health executives. It is providing strong ROI for many of the adapters applying it to improve care and increase efficiency of equipment usage, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wi-Fi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.
It was not long after mankind invented the wheel, carts came around. Throughout history people have been mounting wheels on boxes, now we have everything from golf carts, shopping carts, hand carts and my personal favorite, hotdog carts. So you might ask yourself, “What is so smart about a medical cart?”
Today’s medical carts have evolved to be more than just a storage box with wheels. Rubbermaid Medical Solutions, one of the largest manufacturers of medical carts, have created a cart that is specially designed to house computers, telemedicine, medical supply goods and to also offer medication dispensing. Currently the computers on the medical carts are used to provide access to CPOE, eMAR, and EHR applications.
With the technology trend of mobility quickly on the rise in healthcare, organizations might question the future viability of medical carts. However a recent HIMSS study showed that cart use, at the point of care, was on the rise from 26 percent in 2008 to 45 percent in 2011. The need for medical carts will continue to grow; as a result, cart manufacturers are looking for innovative ways to separate themselves from their competition. Medical carts are evolving from healthcare products to healthcare solutions. Instead of selling medical carts with web cameras, carts manufacturers are developing complete telemedicine solutions that offer remote appointments throughout the country, allowing specialist to broaden their availability with patients in need. Carts are even interfaced with eMAR systems that are able to increase patient safety; the evolution of the cart is rapidly changing the daily functions of the medical field.
Some of the capabilities for medical carts of the future will be to automatically detect their location within a healthcare facility. For example if a cart is improperly stored in a hallway for an extended period of time staff could be notified to relocate it in order to comply to the Joint Commission’s requirements. Real-time location information for the carts could allow them to automatically process tedious tasks commonly performed by healthcare staff. When a cart is rolled into a patient room it could automatically open the patient’s electronic chart or give a patient visit summary through signals exchanged between then entering cart and the logging device kept in the room and effectively updated.
Autonomous robots are now starting to be used in larger hospitals such as the TUG developed by Aethon. These robots increase efficiency and optimize staff time by allowing staff to focus on more mission critical items. Medical carts in the near future will become smart robotic devices able to automatically relocate themselves to where they are needed. This could be used for scheduled telemedicine visits, the next patient in the rounding queue or for automated medication dispensing to patients.
Innovation will continue in medical carts as the need for mobile workspaces increase. What was once considered a computer in a stick could be the groundwork for care automation in the future.
This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.
In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems. While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.
While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.
This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.
Two areas we can see immediate value in are:
Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for. Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.
Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.
Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.
[...] medical practice billing software encourage [...]
I’ve written a number of articles and a few video interviews on job opportunities in digital health recently and have received a steady stream of questions since then. Given healthcare IT professionals can make $90,000 or more annually, there has been growing interest in the industry. To help separate fact from fiction and dive a little deeper in to the realities of these opportunities, I reached out to Beth Kelly, a freelance writer from Chicago, IL to summarize the projected outlook for specialized positions within the field of health IT. Careers in healthcare IT are appealing whether your preference lies within the computer or medical sciences; what’s clear though is to succeed you’ll need to have your passion fit somewhere between both. As positions in the industry are constantly evolving, the ability to adapt to new technology is also crucial — whatever is “cool” today will be different tomorrow. As healthcare providers and physicians strive to implement new technology systems, the expertise of HIT professionals will guide the industry into the future so knowing the Outcome Driven Innovation (OID) and JTBD of clinical professionals will be a differentiator for those who possess such skills. The market for health care information technology continues to show enormous growth potential – with no signs of slowing down any time soon. Here’s what Beth thinks the outlook is:
General Qualifications and Useful Certifications
It’s clear that the expanding field of healthcare IT affords plenty of opportunities. But of course, making the move into this field isn’t as simple as picking up the phone and interviewing. Qualifications are important — in a recent salary survey report completed by HealthITJobs.com, it was noted that certified workers are on average making $10,000+ more than those without certifications. If you are an IT worker currently, CISSP, CCNA, and PMP are a few technical certifications that are in high demand in Healthcare IT. But beyond the classroom, health IT requires a unique set of skills, and not all of them are related to technology. In healthcare, the right applicant needs to understand more than codes and processes. Many hiring managers look for applicants with “soft skills” who are willing to work in a highly collaborative environment. Applicants for HIT positions need to be aware that in a hospital environment, their position is not the star of the show. Ultimately the healthcare world revolves around the patient, and IT roles provide supportive care. In many cases when hiring, institutions prefer applications with a combination of IT and clinical skills.
Optimizing opportunities afforded by the changing healthcare landscape requires a lot of hard work and insight into the diverse nature of the healthcare IT job market. Whether you are transitioning to IT from a clinician position, or you have an IT background already but are new to healthcare, challenges are inevitable. But in an increasingly digital world, where people use technology in more ways perhaps than they even realize, an HIT skill set is almost guaranteed to pay off.
The healthcare sector of IT is as diverse as the industry itself. There are numerous areas in which to specialize; the following domains being several of the most promising.
Looking purely at the numbers, Americans are inseparable from their phones. And with nearly one third of all mobile applications being health related, the opportunity to access and utilize vast amounts of health data is there, also. As Silicon Valley tech companies take a greater interest in mobile health devices, advances in analytic software now make it possible to capture illuminating data about our daily lives. The sum of this information is aimed to transform medicine. Even as privacy concerns loom, the ubiquity of smartphones and tablets promises career opportunities in the realm of HIT.
Joseph Hobbs, CIO at Community Hospital at Anderson located in Anderson, Indiana, had this to say about mobile technologies: “This is a huge topic for any organization. Whether it is a mobile cart, a tablet or a smartphone, you need to give caregivers access at their fingertips. The [other] challenge in healthcare is that it’s not a one-size-fits-all initiative. Beyond just finding a solution for all you then have to worry about security and application presentation to all of these types of devices.”
Many health professionals agree that the data from medical devices and data from modern EHR solutions should be integrated. When mobile devices are capable of being linked to EHR, physicians can provide patients with appointment alerts and medication reminders, as well as additional medical assistance. In the remote patient monitoring space, cell service provider Verizon represents the Converged Health Management solution, one of the first products that hopes to bridge the gap between monitoring devices and EHRs. Partnering with Ideal Life, a medical device company, Verizon’s platform is capable of measuring blood pressure, oxygen saturation, glucose levels and weight.
The market for mobile healthcare apps promises many new opportunities for with room tremendous growth and earning potential. According to German market research firm research2guidance, the worldwide market for mobile health applications and their corresponding services reached $2.4 billion in revenue in 2013 and will grow to $26 billion by the end of 2017.
Mobile apps are becoming increasingly significant in the healthcare community, their influence extending throughout both the medical and insurance industries. Mobile app developer positions are in extremely high demand. With medical health app growth ahead of the general mobile market, there are tremendous number of opportunities for people interested in these positions. According to the U.S. Bureau of Labor and Statistics, from the years 2010-2020, there is a projected growth rate of 57.4% for software application developers. For software systems developers, there is a projected growth rate of 71.7%. It’s estimated that overall employment in the industry will continue to grow rapidly.
Clinical analytics are a top priority for two reasons: data mined by those with analytic skill can be used to understand population health, helping better identify infectious disease outbreaks and other population health trends, and can also be used to help a hospital’s bottom line. Big data allows providers to better see how their resources are spent, and where they can trim the fat. The recent deal between Apple and IBM only promises to fuel the market for data analyst positions.
In the current market, an advanced degree in health informatics is very useful. Because of the move toward electronic health records, hospitals and health systems need qualified people to undertake complex projects. A degree opens the door to working for a hospital, a health system, a vendor that sells electronic records or computer software or as a professional consultant. From 2010 to 2020, the U.S. bureau of Labor has said that employment of computer systems analysts in computer systems design and related services will grow 43 percent. Businesses will typically hire them to reorganize IT departments to operate more efficiently.
HIPAA, Meaningful Use and ICD-10 Project Managers
Now that both HIPAA and HITECH are being fully enforced, affected entities can be audited for compliance at any time. At Stage 2 of the HITECH act a certain percentage of provider’s patients must use and interact with patient portals. Navigating HIPAA privacy regulations and the proprietary nature of the portal software is a convoluted process. And the transition from ICD-9-CM to ICE-10-CM is a hefty task as well; ICD-9-CM contains 13,000 3-5-character alphanumeric diagnosis codes with 855 code categories. ICD-10-CM contains 68,000 3-7-character alphanumeric diagnosis codes with 2,033 code categories. In the transition to greater coding specificity, hospitals typically look for someone who has worked as a coder and in health information management roles.
As health organizations strive toward integrating ICD-10 throughout every aspect of their business, there is an enormous need for medical coding and billing specialists capable of working with the updated diagnostic coding system. ICD-10 skills will put you in the front running for an in-demand position such as project manager, ICD-10 coding specialist, or even ICD-10 educator.
Skills in HIPAA Compliance qualify you for a high level HIPAA Privacy Officer position, a role that typically pays over $60,000 annually. Meaningful Use Director positions, a recent addition to the healthcare landscape, can pay anywhere between $35-80,000 each year.
Privacy and Data Breach Prevention Specialists
Health Information privacy specialists are in extremely high demand. EHR applications, particularly when accessed on mobile devices, require enhanced security access and monitoring. Data breaches are expensive, embarrassing, and damaging to to health groups, but many physicians still neglect to encrypt the patient information they’ve stored on various devices. Healthcare organizations need to take security seriously, and bring on IT professionals to ensure they are doing everything they can to reduce instances of identity theft.
Information security spending is expecting to increase nationwide, especially within industries that deal with sensitive information such as hospitals. New security measures are added and reconfigured constantly, and as a result the demand for privacy and data protection specialists is always high. Job growth for this title is projected to grow upwards of 25% within the next 5-10 years.
Pharmaceutical companies, naturally interested in joining the digital health movement as well, have found it more difficult to gain traction. A 2013 Deloitte survey found that, while people trust doctors and medical professionals the most, they trust companies like WedMD next and then internet search results. Big pharma companies come in dead last. Healthcare organizations and pharma companies are competing, not within their respective sectors, but against one another. Digital pharma is only now beginning to take off. According to M2i2′s Chief Medical Information and Innovation Officer Sachin Jain in a May interview, “the ultimate incentive is that we as a company are gradually finding our way into the outcomes improvement business, as opposed to the pill and vaccine business, and as we do that, I think we realize that data and technology and HIT is going to be a critical enabler.”
Getting started in healthcare IT is not as intimidating as it may seem. For new job seekers, however, it is important to research the different types of positions available and where you may be most helpful. Additionally, for those without a background in health, learning clinical workflows and the other processes that go into healthcare is imperative. Experience, if it’s outside the realm of healthcare, can be transferable, but you will need to be sure to tailor your resume and cover letter around the language of the health industry. If possible, volunteer in a hospital or similar healthcare IT setting to obtain hands-on experience.
Unlike humans, which can handle diversity, computers hate variations. Hospitals and physicians have experienced workflow disruptions and productivity loss as they adopt more advanced EHR systems. Health IT workers, cogs in the digital health machine, fulfill hybrid roles that blend the skills of clinicians and traditional IT workers. As the nature of the healthcare industry continues to evolve, the future for healthcare IT continues to look very bright.
I’ve been interested in the new “wearables” segment for a while. I reached out to Cameron Graham, the managing editor at TechnologyAdvice where he oversees market research for emerging technology, to give us some evidence-driven advice about wearables that entrepreneurs, innovators, healthcare providers, and payers can use for decision making. Specifically, what does the current research show and what are the actionable insights for how to incentivize patients to use them and figure out why patients might pay for them? Cameron thinks that wearable health technology could help improve patient outcome monitoring, if insurance companies and providers work together. He elaborated:
Wearable health technology (or mHealth as some call it) is one of the emerging frontiers in medicine. Fitness tracking devices could allow the healthcare industry to better measure patient outcomes, monitor patient populations for emerging trends, and give preventative healthcare advice based on quantitative measurements (such as daily step counts or heart-rate). We surveyed 979 US adults about their fitness tracking habits, in order to determine current the usage rate for this technology. We then further surveyed 419 of those adults, who identified as non-trackers, about what incentives would convince them to use wearable health monitors. Here are some of our takeaways for vendors and providers:
1. The wearable health market remains small, but is growing steadily
In order to gauge how many adults are currently generating personal health data that would be useful in either patient treatment or preventative medicine, we asked a random, nationwide sample of adults whether they currently tracked their weight, diet, or exercise using a fitness tracking device or smartphone app.
74.9 percent of respondents indicated they did not track any of those variables using either a fitness tracker or smartphone app. 25.1 percent reported tracking such stats.
Out of the roughly one quarter of adults who do track their fitness, 14.1 percent said they used a smartphone app, and 11 percent said they used a fitness tracker. There is currently little data on such demographics, although the Pew Internet Research Project conducted a survey in 2012 looking at similar trends. In their report, they noted that seven percent of adults tracked health indicators using an app. Combining these results, we can see that the market for health tracking applications has approximately doubled over the last two years.
As more consumers adopt such technology, and rely on it for monitoring their health, providers need to become involved in the discussion. There is limited data that can be draw from a sample of just 25 percent of a patient population. If providers can encourage adoption among a majority of their patients however, they will gain greater insight into current health habits, and be able to provide more tailored advice.
2. Physicians can play a large role in encouraging tracking but there are are few incentives in place for them to do so
Looking into what incentives could convince non-tracking adults to use such devices, we found great potential for healthcare providers to encourage tracking habits among their patients. It appears patients want their physicians involved more in monitoring but our healthcare system doesn’t have the right incentives or payment structures available to compensate providers.
48.2 percent of adults said they would use a wearable fitness tracker if their physician provided one. While this may be financially unrealistic for smaller practices, wearable activity trackers (like the FitBit or Jawbone UP) will likely become cheaper as more sophisticated, multi-purpose devices enter the market, such as the forthcoming Apple Watch.
If physicians were able to get half of the three-quarters of non-tracking adults to start measuring their fitness with wearable devices, it would create huge amounts of patient-generated data for the healthcare industry to analyze.
The infrastructure for handling this data is largely in place. The most popular electronic health record provider, Epic Systems, recently announced a partnership with Apple that will allow hospitals to easily integrate wearable data through Apple’s HealthKit platform into patient portals and records.
Promoting the use of such devices should now be a goal for physicians looking to gain greater insight into their patient population. The question would be why Physicians would do this without additional compensation either directly from their patients or indirectly through insurers.
3. Insurance companies and providers need to form partnerships
While a significant portion of adults would use physician-provided devices, health insurance companies may be the ultimate key to promoting widespread fitness tracker adoption.
A total of 57.1 percent of respondents said they would be more likely (or much more likely) to wear a fitness a tracker if they could receive lower health insurance premiums. In fact, this was a more compelling incentive than the possibility of receiving better healthcare advice from their physician (just 44.3 percent of respondents said that would make them more likely to use a tracker).
By agreeing to use a fitness tracker, insurance customers would become eligible for special discounts, perhaps for walking a set number of steps each day, or raising their heartbeat for a certain period of time. Discounts could be given out directly or through an employer.
Some companies are already experimenting with such systems. Humana insurance has a new Vitality program that allows employees to opt-in to fitness tracking in exchange for possible discounts. Car insurance companies have also found success by offering lower rates for safe-driving, as measured through in-car tracking devices.
If providers want to encourage fitness and health tracking among their patients, they should evaluate the possibility of providing devices to their patients, either for free or at a reduced cost. At the very least, they should make patients aware of the benefits of such devices, and encourage them to automatically share such data through their patient portal.
Long term, providers will likely need to collaborate with insurance companies in order to establish a data sharing system for such information, which can allow for physicians to better monitor their patient population, and provide more accurate, tailored diagnoses. A universal patient record system would be ideal, although given current interoperability standards, an insurance-provider arrangement is more likely.
MedCityNews invited me to attend their ENGAGE “Innovation in Patient Engagement” Conference and I found the content, speakers, and overall quality quite good. Since I chair several conferences every year I know how hard it is to pull off a good one so I’d like to congratulate MedCityNews for pulling off a great event. I asked HITSphere‘s Vik Subbu, our Digital Health editor that focuses on Bio IT and Pharma IT, to summarize what we learned at the event. Here’s Vik’s recap of the conference:
The goal of the ENGAGE was to highlight the importance of patient awareness and engagement in developing and managing novel digital health innovations. The conference was attended by industry experts from various disciplines ranging from academic hospitals, non-profit organizations, digital health start-ups, venture capital, service providers and pharmaceutical companies. The interactions between product developers and patients proved to be worthwhile as it is often rare to get both ends of the spectrum together. The point of the conference, driven home in almost every session, was that having patient (i.e. customer) input early on shapes better product development decisions and viewpoints.
Top Nine Insights for digital health innovators and providers:
Did you attend ENGAGE? What did you learn? Please share your thoughts below.
“Large collections of electronic patient records have long provided abundant, but under-explored information on the real-world use of medicines. But when used properly these records can provide longitudinal observational data which is perfect for data mining,” Duan said. “Although such records are maintained for patient administration, they could provide a broad range of clinical information for data analysis. A growing interest has been drug safety.”
In this paper, the researchers proposed two novel algorithms—a likelihood ratio model and a Bayesian network model—for adverse drug effect discovery. Although the performance of these two algorithms is comparable to the state-of-the-art algorithm, Bayesian confidence propagation neural network, by combining three works, the researchers say one can get better, more diverse results.
I saw this a few weeks ago, and while I haven't had the time to delve deep into the details of this particular advance, it did at least give me more reason for hope with respect to the big picture of which it is a part.
It brought to mind the controversy over Vioxx starting a dozen or so years ago, documented in a 2004 article in the Cleveland Clinic Journal of Medicine. Vioxx, released in 1999, was a godsend to patients suffering from rheumatoid arthritic pain, but a longitudinal study published in 2000 unexpectedly showed a higher incidence of myocardial infarctions among Vioxx users compared with the former standard-of-care drug, naproxen. Merck, the patent holder, responded that the difference was due to a "protective effect" it attributed to naproxen rather than a causative adverse effect of Vioxx.
One of the sources of empirical evidence that eventually discredited Merck's defense of Vioxx's safety was a pioneering data mining epidemiological study conducted by Graham et al. using the live electronic medical records of 1.4 million Kaiser Permanente of California patients. Their findings were presented first in a poster in 2004 and then in the Lancet in 2005. Two or three other contemporaneous epidemiological studies of smaller non-overlapping populations showed similar results. A rigorous 18-month prospective study of the efficacy of Vioxx's generic form in relieving colon polyps showed an "unanticipated" significant increase in heart attacks among study participants.
Merck's withdrawal of Vioxx was an early victory for Big Data, though it did not win the battle alone. What the controversy did do was demonstrate the power of data mining in live electronic medical records. Graham and his colleagues were able to retrospectively construct what was effectively a clinical trial based on over 2 million patient-years of data. The fact that EMR records are not as rigorously accurate as clinical trial data capture was rendered moot by the huge volume of data analyzed.
Today, the value of Big Data in epidemiology is unquestioned, and the current focus is on developing better analytics and in parallel addressing concerns about patient privacy. The HITECH Act and Obamacare are increasing the rate of electronic biomedical data capture, and improving the utility of such data by requiring the adoption of standardized data structures and controlled vocabularies.
We are witnessing the dawning of an era, and hopefully the start of the transformation of our broken healthcare system into a learning organization.
I believe if we reduce the time between intention and action, it causes a major change in what you can do, period. When you actually get it down to two seconds, it’s a different way of thinking, and that’s powerful. And so I believe, and this is what a lot of people believe in academia right now, that these on-body devices are really the next revolution in computing.
I am convinced that wearable devices, in particular heads-up devices of which Google Glass is an example, will be playing a major role in medical practice in the not-too-distant future. The above quote from Thad Starner describes the leverage point such devices will exploit: the gap that now exists between deciding to make use of a device and being able to carry out the intended action.
Right now it takes me between 15 and 30 seconds to get my iPhone out and do something useful with it. Even in its current primitive form, Google Glass can do at least some of the most common tasks for which I get out my iPhone in under five seconds, such as taking a snapshot or doing a Web search.
Closing the gap between intention and action will open up potential computing modalities that do not currently exist, entirely novel use case scenarios that are difficult even to envision before a critical mass of early adopter experience is achieved.
The Technology Review interview from which I extracted the quote raises some of the potential issues wearable tech needs to address, but the value proposition driving adoption will soon be truly compelling.
I'm adding some drill-down links below.
Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.
One bit of good news about the Patient Centered Medical Home (PCMH) model: here is a study showing that in spite of considerable challenges to PCMH implementation, the transformations it embodies can be and are being implemented even in small primary care practices serving disadvantaged populations.
We are delighted to introduce our new series of Health Insights. These free to attend events for healthcare professionals feature interactive round table activities, news on how the latest innovations support the health and care community, and best practice experiences from NHS Trust colleagues.
CLICK HERE TO SEE NEW DATES AND LOCATIONS
Starting in Leeds and Newbury this October and held in association with NHS England, each one day conference will feature:
Digital Discovery Sessions
- facilitated round tables exploring procurement issues
An update from NHS England on Tech Funds and Open Source Programme
Host Roy Lilley, popular Healthcare Broadcaster, with lively panel debates
Speakers will include Rob Webster, CEO of NHS Confederation, Tim Straughan, Director of Health and Innovation at Leeds and Partners, and Clive Kay, Chief Executive of Bradford Teaching Hospitals.
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We hope to see you at your local Health Insights.
Twitter, like the Internet in general, has become a vast source of and resource for health care information. As with other tools on the Internet it also has the potential for misinformation to be distributed. In some cases this is done by accident by those with the best intentions. In other cases it is done on purpose such as when companies promote their products or services while using false accounts they created.
In order to help determine the credibility of tweets containing health-related content I suggest the using the following checklist (adapted from Rains & Karmikel, 2009):
Ultimately it is up to the individual to determine how to use health information they find on Twitter or other Internet sources. For patients anecdotal or experiential information shared by others with the same illness may be considered very credible. Others conducting research may find this a less valuable information source. Conversely a researcher may only be looking for tweets that contain reference to peer-reviewed journal articles whereas patients and their caregivers may have little or no interest in this type of resource.
Rains, S. A., & Karmike, C. D. (2009). Health information-seeking and perceptions of website credibility: Examining Web-use orientation, message characteristics, and structural features of websites. Computers in Human Behavior, 25(2), 544-553.
The altmetric movement is intended to develop new measures of production and contribution in academia. The following article provides a primer for research scholars on what metrics they should consider collecting when participating in various forms of social media.
If you participate on Twitter you should be keeping track of the number of tweets you send, how many times your tweets are replied to, re-tweeted by other users and how many @mentions (tweets that include your Twitter handle) you obtain. ThinkUp is an open source application that allows you to track these metrics as well as other social media tools such as Facebook and Google +. Please read my extensive review about this tool. This service is free.
You should register with a domain shortening service such as bit.ly, which will provide you with an API key that you can enter into applications you use to share links. This will provide a means to keep track of your click-through statistics in one location. Bit.ly records how many times a link you created was clicked on, the referrer and location of the user. Consider registering your own domain name and using it to shorten your tweets as a means of branding. In addition, you can use your custom link on electronic copies of your CV or at your own web site. This will inform you when your links have been clicked on. You should also consider using bit.ly to create links used at your web site, providing you with feedback on which are used the most often. For example, all of the links in this article were created using my custom bit.ly domain. In addition, you can tweet a link to any research study you publish to publicize as well as keep track of how many clicks are obtained. Bit.ly is a free service.
Another tool to measure your tweets is TweetReach. This service allows you to track the reach of your tweets by Twitter handle or tweet. It provides output in formats that can be saved for use elsewhere (Excel, PDF or the option to print or save your output by link). To use these latter features you must sign up for an account but the service is free.
Buffer is a tool that allows you to schedule your tweets in advance. You can also connect Buffer to your bit.ly account so links used can be included in your overall analytics. Although Buffer provides its own measures on click-through counts this can contradict what appears in bit.ly. This service is free but also has paid upgrade options available that provide more detailed analytics.
Google Scholar Citation Profile
You can set up a profile with Google Scholar based on your publication record. The metrics provided by this service include a citation count, h-index and i10-index. When someone searches your name using Google Scholar your profile will appear at the top before any of the citations. This provides a quick way to separate your articles from someone else who has the same name as you.
Google Feedburner for RSS feeds
If you maintain your own web site and use RSS feeds to announce new postings you can also collect statistics on how many times your article is clicked on. Feedburner, recently acquired by Google provides one way to measure this. You enter your RSS feed ULR and a report is generate, which can be saved in CVS format.
Journal article download statistics
Many journals provide statistics on the number of downloads of articles. Keep track of those associated with your publication by visiting the site. For example, BioMed Central (BMC) maintains an access count of the last 30 days, one year and all time for each of your publications.
Other means of contributing to the knowledge base in your field include participating on web-based forums or web sites such as Quora. Quora provides threaded discussions on topics and allows participants to both generate and respond to the question. Other users vote on your responses and points are accrued. If you want another user to answer your question you must “spend” some of your points. Providing a link to your public profile on Quora on your CV will demonstrate another form of contribution to your field.
Paper.li is a free service that curates content and renders it in a web-based format. The focus of my Paper.li is the use of technology in Canadian Healthcare. I have also created a page that appears at my web site. Metrics on the number of times your paper has been shared via Facebook, Twitter, Google + and Linked are available. This service is free.
Twylah is similar to paper.li in that it takes content and displays it in a newspaper format except it uses your Twitter feed. There is an option to create a personalized page. I use tweets.lauraogrady.ca. I also have a Twylah widget at my web site that shows my trending tweets in a condensed magazine layout. It appears in the side bar. This free service does not yet provide metrics but can help increase your tweet reach. If you create a custom link for your Twylah page you can keep track of how many people visit it.
Analytics for your web site
Log file analysis
If you maintain your own web site you can use a variety of tools to capture and analyze its use. One of the most popular applications is Google Analytics. If you are using a content management system such as WordPress there are many plug-ins that will add the code to the pages at your site and produce reports. WordPress also provides a built-in analytic available through its dashboard.
If you have access to the raw log files you could use a shareware log file program or the open source tool Piwik. These tools will provide summaries about what pages of your site are visited most frequently, what countries the visitors come from, how long visitors remain at your site and what search terms are used to reach your site.
All of this information should be included in the annual report you prepare for your department and your tenure application. This will increase awareness of altmetrics and improve our ability to have these efforts “count” as contributions in your field.